USE OF INTRAOPERATIVE HIGH-RESOLUTION ESOPHAGEAL MANOMETRY AND ENDOLUMINAL FUNCTIONAL LUMEN IMAGING PROBE (ENDOFLIP) TO GUIDE LAPAROSCOPIC HELLER MYOTOMY IN PEDIATRIC ESOPHAGEAL ACHALASIA
DDW ePoster Library. Edwards P. 05/23/21; 320882; Su404
Price Edwards
Contributions
Contributions
Abstract
Engage with the presenter here during ePoster Session: Pediatric Functional and Motility Disorders
On Sunday, May 23, 2021 12:15 - 1 p.m. EDT
Number: Su404
USE OF INTRAOPERATIVE HIGH-RESOLUTION ESOPHAGEAL MANOMETRY AND ENDOLUMINAL FUNCTIONAL LUMEN IMAGING PROBE (ENDOFLIP) TO GUIDE LAPAROSCOPIC HELLER MYOTOMY IN PEDIATRIC ESOPHAGEAL ACHALASIA
Society: AGA
Track: Functional GI and Motility Disorders
Category: Pediatric Gastroenterology & Developmental Biology
Author(s): Price T. Edwards1,2, Bruno P. Chumpitazi1,2, Danielle Hsu1,2, Eric Chiou1,21 Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Memphis, Texas, United States; 2 Texas Children's Hospital, Houston, Texas, United States
Background: Although laparoscopic Heller myotomy (LHM) combined with Dor fundoplication is a proven treatment for achalasia, a subset of patients may have persistent dysphagia due to incomplete myotomy or excessively tight fundoplication. We assessed the feasibility and impact of intraoperative High-Resolution Esophageal Manometry (HREM) and the endoluminal functional lumen imaging probe (EndoFLIP) during the LHM procedure. To our knowledge, these have not been concurrently used during LHM to guide the management of children with esophageal achalasia.
Objectives: In children with esophageal achalasia undergoing LHM 1) Determine the feasibility of intraoperative HREM and EndoFLIP during LHM; 2) Characterize the changes in EGJ pressure and distensibility at various intervals during LHM with Dor fundoplication.
Methods: Retrospective review was completed for children with achalasia who underwent LHM and Dor fundoplication with intraoperative HREM and EndoFLIP testing performed between January 2020 and December 2020. EGJ pressure was recorded pre-myotomy, post-myotomy, and after the completion of a Dor fundoplication using HREM. Minimum esophageal diameter and EGJ distensibility were measured at 30mL and 40mL distension volumes pre-myotomy and after fundoplication using EndoFLIP. Data displayed as median with interquartile range.
Results: Six patients met criteria for inclusion. Median age was 13.5 years (IQR 7.25-14.5). All 6 patients had intraoperative HREM (pre-myotomy, post-myotomy, and post-fundoplication) (Figure 1). Four patients had EndoFLIP data from both pre-myotomy and post-fundoplication. There were no complications arising from the use of intraoperative HREM and EndoFLIP. EGJ pressure differed significantly pre-myotomy compared to post-myotomy [31.5 mmHg (13.28-42.5) vs. 6 mmHg (5.5-25.5), p=0.01)]. Post-myotomy and post-fundoplication LES pressures did not differ significantly. EndoFLIP data showed post-fundoplication esophageal minimum diameter increased significantly compared with pre-myotomy at 40 mL [4.8 mm (4.7-5.4) versus 9.9 mm (7.2-12.9) p=0.004]. There was also a trend toward increased post-fundoplication EGJ distensibility and cross-sectional area compared with pre-myotomy measurements (Table 1).
Conclusions: Concurrent HREM and EndoFLIP during LHM with Dor fundoplication is safe and feasible in children with achalasia. EGJ pressure decreases significantly while minimum esophageal diameter increases significantly with LHM. Future evaluations are needed to determine whether intraoperative testing can be used to optimize clinical outcomes related to LHM.
On Sunday, May 23, 2021 12:15 - 1 p.m. EDT
Number: Su404
USE OF INTRAOPERATIVE HIGH-RESOLUTION ESOPHAGEAL MANOMETRY AND ENDOLUMINAL FUNCTIONAL LUMEN IMAGING PROBE (ENDOFLIP) TO GUIDE LAPAROSCOPIC HELLER MYOTOMY IN PEDIATRIC ESOPHAGEAL ACHALASIA
Society: AGA
Track: Functional GI and Motility Disorders
Category: Pediatric Gastroenterology & Developmental Biology
Author(s): Price T. Edwards1,2, Bruno P. Chumpitazi1,2, Danielle Hsu1,2, Eric Chiou1,21 Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Memphis, Texas, United States; 2 Texas Children's Hospital, Houston, Texas, United States
Background: Although laparoscopic Heller myotomy (LHM) combined with Dor fundoplication is a proven treatment for achalasia, a subset of patients may have persistent dysphagia due to incomplete myotomy or excessively tight fundoplication. We assessed the feasibility and impact of intraoperative High-Resolution Esophageal Manometry (HREM) and the endoluminal functional lumen imaging probe (EndoFLIP) during the LHM procedure. To our knowledge, these have not been concurrently used during LHM to guide the management of children with esophageal achalasia.
Objectives: In children with esophageal achalasia undergoing LHM 1) Determine the feasibility of intraoperative HREM and EndoFLIP during LHM; 2) Characterize the changes in EGJ pressure and distensibility at various intervals during LHM with Dor fundoplication.
Methods: Retrospective review was completed for children with achalasia who underwent LHM and Dor fundoplication with intraoperative HREM and EndoFLIP testing performed between January 2020 and December 2020. EGJ pressure was recorded pre-myotomy, post-myotomy, and after the completion of a Dor fundoplication using HREM. Minimum esophageal diameter and EGJ distensibility were measured at 30mL and 40mL distension volumes pre-myotomy and after fundoplication using EndoFLIP. Data displayed as median with interquartile range.
Results: Six patients met criteria for inclusion. Median age was 13.5 years (IQR 7.25-14.5). All 6 patients had intraoperative HREM (pre-myotomy, post-myotomy, and post-fundoplication) (Figure 1). Four patients had EndoFLIP data from both pre-myotomy and post-fundoplication. There were no complications arising from the use of intraoperative HREM and EndoFLIP. EGJ pressure differed significantly pre-myotomy compared to post-myotomy [31.5 mmHg (13.28-42.5) vs. 6 mmHg (5.5-25.5), p=0.01)]. Post-myotomy and post-fundoplication LES pressures did not differ significantly. EndoFLIP data showed post-fundoplication esophageal minimum diameter increased significantly compared with pre-myotomy at 40 mL [4.8 mm (4.7-5.4) versus 9.9 mm (7.2-12.9) p=0.004]. There was also a trend toward increased post-fundoplication EGJ distensibility and cross-sectional area compared with pre-myotomy measurements (Table 1).
Conclusions: Concurrent HREM and EndoFLIP during LHM with Dor fundoplication is safe and feasible in children with achalasia. EGJ pressure decreases significantly while minimum esophageal diameter increases significantly with LHM. Future evaluations are needed to determine whether intraoperative testing can be used to optimize clinical outcomes related to LHM.
Engage with the presenter here during ePoster Session: Pediatric Functional and Motility Disorders
On Sunday, May 23, 2021 12:15 - 1 p.m. EDT
Number: Su404
USE OF INTRAOPERATIVE HIGH-RESOLUTION ESOPHAGEAL MANOMETRY AND ENDOLUMINAL FUNCTIONAL LUMEN IMAGING PROBE (ENDOFLIP) TO GUIDE LAPAROSCOPIC HELLER MYOTOMY IN PEDIATRIC ESOPHAGEAL ACHALASIA
Society: AGA
Track: Functional GI and Motility Disorders
Category: Pediatric Gastroenterology & Developmental Biology
Author(s): Price T. Edwards1,2, Bruno P. Chumpitazi1,2, Danielle Hsu1,2, Eric Chiou1,21 Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Memphis, Texas, United States; 2 Texas Children's Hospital, Houston, Texas, United States
Background: Although laparoscopic Heller myotomy (LHM) combined with Dor fundoplication is a proven treatment for achalasia, a subset of patients may have persistent dysphagia due to incomplete myotomy or excessively tight fundoplication. We assessed the feasibility and impact of intraoperative High-Resolution Esophageal Manometry (HREM) and the endoluminal functional lumen imaging probe (EndoFLIP) during the LHM procedure. To our knowledge, these have not been concurrently used during LHM to guide the management of children with esophageal achalasia.
Objectives: In children with esophageal achalasia undergoing LHM 1) Determine the feasibility of intraoperative HREM and EndoFLIP during LHM; 2) Characterize the changes in EGJ pressure and distensibility at various intervals during LHM with Dor fundoplication.
Methods: Retrospective review was completed for children with achalasia who underwent LHM and Dor fundoplication with intraoperative HREM and EndoFLIP testing performed between January 2020 and December 2020. EGJ pressure was recorded pre-myotomy, post-myotomy, and after the completion of a Dor fundoplication using HREM. Minimum esophageal diameter and EGJ distensibility were measured at 30mL and 40mL distension volumes pre-myotomy and after fundoplication using EndoFLIP. Data displayed as median with interquartile range.
Results: Six patients met criteria for inclusion. Median age was 13.5 years (IQR 7.25-14.5). All 6 patients had intraoperative HREM (pre-myotomy, post-myotomy, and post-fundoplication) (Figure 1). Four patients had EndoFLIP data from both pre-myotomy and post-fundoplication. There were no complications arising from the use of intraoperative HREM and EndoFLIP. EGJ pressure differed significantly pre-myotomy compared to post-myotomy [31.5 mmHg (13.28-42.5) vs. 6 mmHg (5.5-25.5), p=0.01)]. Post-myotomy and post-fundoplication LES pressures did not differ significantly. EndoFLIP data showed post-fundoplication esophageal minimum diameter increased significantly compared with pre-myotomy at 40 mL [4.8 mm (4.7-5.4) versus 9.9 mm (7.2-12.9) p=0.004]. There was also a trend toward increased post-fundoplication EGJ distensibility and cross-sectional area compared with pre-myotomy measurements (Table 1).
Conclusions: Concurrent HREM and EndoFLIP during LHM with Dor fundoplication is safe and feasible in children with achalasia. EGJ pressure decreases significantly while minimum esophageal diameter increases significantly with LHM. Future evaluations are needed to determine whether intraoperative testing can be used to optimize clinical outcomes related to LHM.
On Sunday, May 23, 2021 12:15 - 1 p.m. EDT
Number: Su404
USE OF INTRAOPERATIVE HIGH-RESOLUTION ESOPHAGEAL MANOMETRY AND ENDOLUMINAL FUNCTIONAL LUMEN IMAGING PROBE (ENDOFLIP) TO GUIDE LAPAROSCOPIC HELLER MYOTOMY IN PEDIATRIC ESOPHAGEAL ACHALASIA
Society: AGA
Track: Functional GI and Motility Disorders
Category: Pediatric Gastroenterology & Developmental Biology
Author(s): Price T. Edwards1,2, Bruno P. Chumpitazi1,2, Danielle Hsu1,2, Eric Chiou1,21 Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Memphis, Texas, United States; 2 Texas Children's Hospital, Houston, Texas, United States
Background: Although laparoscopic Heller myotomy (LHM) combined with Dor fundoplication is a proven treatment for achalasia, a subset of patients may have persistent dysphagia due to incomplete myotomy or excessively tight fundoplication. We assessed the feasibility and impact of intraoperative High-Resolution Esophageal Manometry (HREM) and the endoluminal functional lumen imaging probe (EndoFLIP) during the LHM procedure. To our knowledge, these have not been concurrently used during LHM to guide the management of children with esophageal achalasia.
Objectives: In children with esophageal achalasia undergoing LHM 1) Determine the feasibility of intraoperative HREM and EndoFLIP during LHM; 2) Characterize the changes in EGJ pressure and distensibility at various intervals during LHM with Dor fundoplication.
Methods: Retrospective review was completed for children with achalasia who underwent LHM and Dor fundoplication with intraoperative HREM and EndoFLIP testing performed between January 2020 and December 2020. EGJ pressure was recorded pre-myotomy, post-myotomy, and after the completion of a Dor fundoplication using HREM. Minimum esophageal diameter and EGJ distensibility were measured at 30mL and 40mL distension volumes pre-myotomy and after fundoplication using EndoFLIP. Data displayed as median with interquartile range.
Results: Six patients met criteria for inclusion. Median age was 13.5 years (IQR 7.25-14.5). All 6 patients had intraoperative HREM (pre-myotomy, post-myotomy, and post-fundoplication) (Figure 1). Four patients had EndoFLIP data from both pre-myotomy and post-fundoplication. There were no complications arising from the use of intraoperative HREM and EndoFLIP. EGJ pressure differed significantly pre-myotomy compared to post-myotomy [31.5 mmHg (13.28-42.5) vs. 6 mmHg (5.5-25.5), p=0.01)]. Post-myotomy and post-fundoplication LES pressures did not differ significantly. EndoFLIP data showed post-fundoplication esophageal minimum diameter increased significantly compared with pre-myotomy at 40 mL [4.8 mm (4.7-5.4) versus 9.9 mm (7.2-12.9) p=0.004]. There was also a trend toward increased post-fundoplication EGJ distensibility and cross-sectional area compared with pre-myotomy measurements (Table 1).
Conclusions: Concurrent HREM and EndoFLIP during LHM with Dor fundoplication is safe and feasible in children with achalasia. EGJ pressure decreases significantly while minimum esophageal diameter increases significantly with LHM. Future evaluations are needed to determine whether intraoperative testing can be used to optimize clinical outcomes related to LHM.
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